Autonomic/CV Drugs — MCQs

A 42-year-old man is discovered unconscious by local police while patrolling in a park. He is unresponsive to stimulation. Syringes were found scattered around him. His heart rate is 70/min and respiratory rate is 6/min. Physical examination reveals a disheveled man with track marks on both arms. His glasgow coma scale is 8. Pupillary examination reveals miosis. An ambulance is called and a reversing agent is administered. Which of the following is most accurate regarding the reversal agent most likely administered to this patient?

A 40-year-old man with alcohol use disorder is brought to the emergency department because of sudden-onset blurry vision, severe upper abdominal pain, and vomiting that started one day after he drank a bottle of paint thinner. Physical examination shows epigastric tenderness without rebound or guarding. Ophthalmologic examination shows a visual acuity of 20/200 bilaterally despite corrective lenses. Arterial blood gas analysis on room air shows: pH 7.21 Sodium 135 mEq/L Chloride 103 mEq/L Bicarbonate 13 mEq/L An antidote with which of the following mechanisms of action is the most appropriate therapy for this patient's condition?

A 36-year-old man is brought to the emergency department by a neighbor with signs of altered mental status. He was found 6 hours ago stumbling through his neighbor's bushes and yelling obscenities. The neighbor helped him home, but found him again 1 hour later slumped over on his driveway in a puddle of vomit. He is oriented to self, but not to place or time. His vitals are as follows: temperature, 36.9°C (98.5°F); pulse, 82/min; respirations, 28/min; and blood pressure, 122/80 mm Hg. Cardiopulmonary examination indicates no abnormalities. He is unable to cooperate for a neurological examination. Physical examination reveals muscle spasms involving his arms and jaw. Laboratory studies show: Na+ 140 mEq/L K+ 5.5 mEq/L CI- 101 mEq/L HCO3- 9 mEq/L Urea nitrogen 28 mg/dL Creatinine 2.3 mg/dL Glucose 75 mg/dL Calcium 7.2 mg/dL Osmolality 320 mOsm/kg The calculated serum osmolality is 294 mOsm/kg. The arterial blood gas shows a pH of 7.25 and a lactate level of 3.2 mmol/L. Urine examination shows oxalate crystals and the absence of ketones. What is the most appropriate treatment indicated for this patient experiencing apparent substance toxicity?

A 48-year-old woman presents to her family practitioner complaining of tremulousness of both hands for the past few years that have deteriorated over the past 7 months. She sometimes spills coffee while holding a full cup. She is a receptionist and her symptoms have led to difficulties with typing at work. She denies weight loss, diarrhea, fatigue, blurring of vision, walking difficulties, and heat intolerance. The past medical history is significant for well-controlled bronchial asthma. She does not smoke or use illicit drugs, but she drinks one cup of coffee daily. She drinks alcohol only socially and has noticed a decrease in her tremors afterward. She reports that her father had a head tremor, and her mother had hyperthyroidism. The patient is oriented to person, place, time and situation. On physical examination, the eye movements are normal and there is no nystagmus. She has a prominent rhythmic tremor of both hands that increase when hands are stretched with abducted fingers. The muscle strength, tone, and deep tendon reflexes are normal in all 4 limbs. The sensory examination and gait are normal. The laboratory test results are as follows: Hemoglobin 14.8 g/dL Leukocytes 5,500/mm3 Platelets 385,000/mm3 BUN 18 mg/dL Creatinine 0.9 mg/dL Na+ 143 mmol/L K+ 4.2 mmol/L Which of the following is the most appropriate management for this patient?

A 65-year-old male with a history of hypertension presents to his primary care physician complaining of multiple episodes of chest pain, palpitations, and syncope. Episodes have occurred twice daily for the last week, and he is asymptomatic between episodes. Electrocardiogram reveals a narrow-complex supraventricular tachycardia. He is treated with diltiazem. In addition to its effects on cardiac myocytes, on which of the following channels and tissues would diltiazem also block depolarization?

A 29-year-old woman presents with low mood and tearfulness on most days for the past 4 weeks. She says that she has been struggling to cope with her life and feels that everything that is going wrong is her fault. She also says that there are nights when she cries herself to sleep as the burden of the whole day is too overwhelming for her. In the last 3 weeks, she cannot recall a day when she felt interested in going out and participating in her daily activities. She also says she doesn’t seem to have much energy and feels fatigued all day. She has lost her appetite and feels that she is losing weight. Over the past month, she also reports experiencing frequent and often unbearable migraine headaches. No significant past medical history. The patient has prescribed a drug for her symptoms which is known to be cardiotoxic and may result in ECG changes. Which of the following is the mechanism of action of the drug most likely prescribed to this patient?

A 59-year-old man presents to a clinic with exertional chest pain for the past several months. He says the pain is central in his chest and relieved with rest. The physical examination is unremarkable. An electrocardiogram is normal, but an exercise tolerance test revealed ST-segment depression in chest leads V1-V4. He is prescribed nitroglycerin to be taken in the first half of the day. Which of the following statements best describes the reason behind the timing of this medication?

A 58-year-old male presents to his primary care physician for a check-up. He reports that he visited an urgent care clinic last week for seasonal allergies; he was instructed at that encounter to follow-up with his primary care doctor because his blood pressure measured at that time was 162/88. He denies any bothersome symptoms and reports that he feels well overall. The patient denies any past history of medical problems other than cholecystitis that was surgically treated over 30 years ago. On further probing through review of symptoms, the patient reports that he often feels 'shaky' when performing tasks; he reports that his hands shake whenever he attempts to eat or drink something and also when he writes. Vital signs obtained at the visit are as follows: T 37.2 C, HR 88, BP 154/96, RR 20, SpO2 98%. A second blood pressure reading 10 minutes after the first set of vitals shows a blood pressure of 150/94. Physical examination is overall unremarkable and does not reveal a resting tremor in either hand; however, when the patient is asked to pick up a pen to fill out insurance paperwork, you note a fine shaking in his right hand. Which of the following is the next best step in the management of this patient?

A primary care physician who focuses on treating elderly patients is researching recommendations for secondary prevention. She is particularly interested in recommendations regarding aspirin, as she has several patients who ask her if they should take it. Of the following, which patient should be started on lifelong aspirin as monotherapy for secondary prevention of atherosclerotic cardiovascular disease?

A 34-year-old man comes to the physician because of palpitations, shortness of breath, diarrhea, and abdominal cramps for 2 months. Physical examination shows cutaneous flushing of the face. Auscultation of the chest shows bilateral wheezing. A 24-hour urine collection shows increased 5-hydroxyindoleacetic acid (5-HIAA) concentration. A contrast-enhanced CT scan of the abdomen shows an intestinal tumor with extensive metastasis to the liver. A diagnosis of an inoperable disease is made and the patient is started on treatment with octreotide. Six weeks later, the patient's symptoms have improved except for his abdominal pain and frequent loose stools. The physician suggests enrolling the patient in a trial to test additional treatment with a new drug that has been shown to improve symptoms in other patients with the same condition. The expected beneficial effect of this new drug is most likely caused by inhibition of which of the following?